- Should patients be screened for iron deficiency? If so, who and how often? (1:40)
- What are the indications for diagnostic endoscopy in iron deficient patients? (3:23)
- How should you advice patients to take oral iron? What is optimal dosing? (5:53)
- In which patients would you consider IV iron? What are the risks? (11:41)
- Throwback Question: What is a medication overuse HA? (14:44)
- Asymptomatic patients at high risk of IDA should probably be screened, but this recommendation is not evidence based and is based on outdated professional society guidelines.
- The interval of repeat screening is also not clear.
- Men and post-menopausal women without any history of overt bleeding should be referred to scope from both upper and lower endoscopy.
- In these populations, there is an increased chance of malignancy, and an even greater chance of other GI pathology that can be intervened on.
- The exact optimal dose of oral iron is not known and likely depends on the individual patient.
- When choosing a dose, one should consider the pharmacology of hepcidin-induced malabsorption and balance this with the patient’s side effect burden.
- Patients should be instructed to NOT take it with food and if possible with vitamin C or citrus food.
- Newer formulations of IV iron are safer and without increased risk for significant adverse reaction or infection.
- It is quicker and more effective than oral iron in repleting stores.
- IV iron should be considered in patients who are poorly tolerating oral Fe SE, have malabsorption disease, ESRD or with ongoing blood loss that oral iron cannot keep up with.
- If you notice your patient’s headache changes from intermittent to a chronic, daily headache while using lots of abortive therapy medications, consider medication overuse headache.
- To avoid medical overuse headache, encourage your patient to limit triptans and NSAIDs to less than 2 times per week on average.
- Don’t confuse medication overuse headache with a medication induced headache, which is most common drugs seen with drugs like nitrates, phosphodiesterase inhibitors, and hormones.
Many thanks to Dr. Poles and Dr. David Green for peer-reviewing this podcast!
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